The Optimal Pyloric Procedure: A Collective Review

ABSTRACT

Vagal damage and subsequent pyloric denervation inevitably occur during esophagectomy,potentially leading to delayed gastric emptying (DGE). The choice of an optimal pyloricprocedure to overcome DGE is important, as such procedures can lead to prolonged surgery,shortening of the conduit, disruption of the blood supply, and gastric dumping/bilereflux. This study investigated various pyloric methods and analyzed comparative studiesin order to determine the optimal pyloric procedure. Surgical procedures for the pylorusinclude pyloromyotomy, pyloroplasty, or digital fracture. Botulinum toxin injection, endoscopicballoon dilatation, and erythromycin are non-surgical procedures. The scope, technique,and effects of these procedures are changing due to advances in minimally invasivesurgery and postoperative interventions. Some comparative studies have shown that pyloricprocedures are helpful for DGE, while others have argued that it is difficult to reach anobjective conclusion because of the variety of definitions of DGE and evaluation methods.In conclusion, recent advances in interventional technology and minimally invasive surgeryhave led to questions regarding the practice of pyloric procedures. However, manyclinicians still perform them and they are at least somewhat effective. To provide guidanceon the optimal pyloric procedure, DGE should first be defined clearly, and a large-scalestudy with an objective evaluation method will then be required.